| NPI | 1235244112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45401) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML20008253) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60001638) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-01-20 |